In pediatric patients with calcium-based stones and hypercalciuria, dietary modification should focus on reducing urinary calcium excretion while supporting normal growth and skeletal health. Adequate, age-appropriate dietary calcium intake (Table 6) is recommended rather than restriction, as low calcium intake increases intestinal oxalate absorption and urinary oxalate excretion, thereby increasing calcium oxalate supersaturation and stone risk. An RCT in an adult population showed lower stone recurrence with a normal calcium multi-intervention diet than with a low calcium diet,29 and the underlying intestinal calcium oxalate binding physiology is likely applicable to children as well, although no RCTs have studied this among children. Studies further support that calcium restriction in children is inappropriate given the risk to bone mineral accrual during critical growth periods. Limiting dietary sodium is also important, as sodium and calcium share renal tubular handling; higher sodium intake increases urinary calcium excretion in both adults and children, while sodium reduction lowers urinary calcium excretion and stone risk.148, 149 A diet rich in fruits and vegetables is recommended to provide dietary alkali, reduce net endogenous acid load, and support higher urinary citrate levels, which together may mitigate calcium stone risk.150 Although adult guidelines often recommend limiting animal protein intake to reduce acid load, urinary calcium, and uric acid excretion, routine restriction of animal protein is not recommended in children. Protein requirements in childhood are higher to support linear growth, neurodevelopment, and overall nutritional adequacy; unnecessary restriction may compromise growth or lead to inadequate intake of iron, zinc, and vitamin B12. Therefore, pediatric nutrition recommendations emphasize a balanced approach which includes avoiding excessive protein intake well above age-based recommendations, while not restricting normal protein consumption and prioritizing sodium reduction and increasing consumption of fruits and vegetables to achieve alkali balance. This strategy appropriately adapts adult stone-prevention principles to pediatric physiology and developmental needs while minimizing unintended nutritional harm.